ABSTRACT
OBJECTIVE: To evaluate the clinical significance of laparoscopic extraperitoneal para-aortic lmphadenectomy(PAL)in high para-aortic lymphadenectomy.METHODS: A non-randomized controlled method was used to analyze the clinical data of laparoscopic extraperitoneal PAL in 35 patients(extraperitoneal group)and laparoscopic transabdominal PAL in 40 patients(transabdominal group)in the Gynecological Department of the First Affiliated Hospital of Xiamen University from March 2018 to April 2019.RESULTS: All the 35 cases of laparoscopic extraperitoneal PAL reached the level of renal vein.Endometrial cancer accounted for the largest proportion,with an average age of 47.57 years and an average body mass index of 23.77.The average operation time was 109 minutes in the first 6 cases and 74.73 minutes in the other 29 cases.The amount of hemorrhage was 15.19 mL,and the average number of para-aortic lymph nodes(PALN)resected was 17.87.There were 5 cases of positive PALN metastasis,and the average gastrointestinal recovery time was13.43 hours.The average postoperative pelvic drainage was 76.57 hours and the average postoperative hospital stay was8.24 days.Intraoperative and postoperative complications included 1 case of inferior vena cava rupture,1 case of chyle leakage,and 1 case of vulvar edema.None of the 40 cases of laparoscopic transabdominal PAL reached the level of renal vein,and endometrial cancer accounted for the largest proportion,with the average age of 46.78 years and the average body mass index of 24.03.The average operation time was 90.55 min;the average intraoperative blood loss was 67.40 mL The average number of para-aortic lymph nodes was 3.30.There was one case of PALN metastasis.The average gastrointestinal recovery time was 22.35 hours,and the average postoperative pelvic drainage time was 75.75 hours.The average length of hospital stay was 8.90 days.There were 2 cases of rupture of the inferior mesenteric artery,3 cases of chyle leakage,and 2 cases of vulvar edema.The number of PALN resection,intraoperative blood loss,and operation time in the extraperitoneal group were not related to the body mass index,but the number of PALN in obese patients in the laparoscopic transabdominal group was significantly reduced,the operation time was longer,the intraoperative blood loss was more,and postoperative gastrointestinal recovery time is longer(P<0.05).CONCLUSION: Laparoscopic extraperitoneal PAL can solve the problems of laparoscopic transabdominal PAL lymph node resection,which is difficult to reach the level of renal vein,intraoperative intestinal tube interference,and the number of lymph nodes resected.It is especially suitable for obese patients.Laparoscopic extra-peritoneal high-grade PAL is safe,feasible,and recommended.
ABSTRACT
<p><b>OBJECTIVE</b>Serum p53 protein overexpression was detected in population exposed to traffic exhaust gas to study the relation between traffic exhaust gas and the increased risk in p53 gene mutation.</p><p><b>METHODS</b>Serum p53 protein expression was measured by enzyme-linked immunosorbent assay. Relationship between different types of job and serum p53 protein overexpression were studied by pearson Chi-square tests.</p><p><b>RESULTS</b>Results on serum p53 protein overexpression on jobs outside of office (5.74%) were not significantly higher than jobs inside the office. However, it suggested that traffic police men (12.12%) working outside of office, with whose length of service longer than 30 years had a significant overexpression of serum p53 protein than the others (5.36%) whose length of service was less than 30 years (P < 0.05, OR = 2.43, 95% CI: 1.11 - 5.33). Overexpression rate of p53 protein appeared to be 6.89% in the group whose average weekly exposure hours were more than 40 hours, which was significant higher than the group whose exposed hours were less than 40 hours (P < 0.05, OR = 1.71, 95% CI: 1.03 - 2.81).</p><p><b>CONCLUSION</b>The result suggested that traffic exhaust gas was likely to cause mutation of p53 gene and increasing the incidence of lung cancer.</p>